NFP While Breastfeeding


I was taught in medical school never to leave a newborn delivery without discussing birth control with the new mother.  The exhausted, delighted mothers and smiling fathers would always give the physician a puzzled look when asked, minutes after delivery, what their birth control plans were.  It seemed like a rude, dark interruption of the joyful fleeting moments after the miracle of birth.

We were also taught, at a Catholic hospital, to discharge post-partum mothers with a prescription for birth control.  “A condom alone is not enough,” and “Breastfeeding is not birth control,” were phrases I heard over and over.  No one talked about Natural Family Planning (NFP) except to say that it was not realistic.  It is shocking to me, as a physician, how few of my colleagues are aware that NFP can be up to 99% effective when practiced appropriately.

Well-meaning obstetricians are eager to hand out hormonal birth control and even sterilization during the immediate post-partum period.  They often tell stories of women who come in pregnant at their six-week follow-up appointment, or cry when they learn that they are pregnant while breastfeeding.  But somehow women don’t know that dangers of hormonal birth control while breastfeeding.  They also don’t know that any medication containing estrogen derivatives can decrease breast milk production; sometimes so much that women are unable to breastfeed.  And very few obstetricians are able to instruct women on natural family planning during breastfeeding and the post-partum period.

Natural Family Planning is a method of avoiding or achieving pregnancy by becoming aware of a woman’s fertile periods and timing intercourse accordingly.  NFP is the only method of birth control which is consistent with the teaching of the Roman Catholic Church and the Theology of the Body.  NFP is not the “rhythm method,” which relies only on timing of a woman’s menstrual cycle.  There are many methods of NFP including the Billings ovulation method, the Creighton Model FertilityCare System, The Symptothermal method (taught by the Couple to Couple League and other organizations), and the Marquette method.

NFP can be challenging during the post-partum period, especially if a mother is breastfeeding.  Breastfeeding causes lactational amenorrhea, a medical term for the absence of a menstrual period while breastfeeding.  During lactational amenorrhea, women experience relative infertility.  Some breastfeeding women will restart their menstrual cycles as early as four months after the birth of their baby, or even sooner if they are supplementing breastfeeding with formula.  Fertility can return before a woman restarts her menstrual cycles, making it difficult for some women to be aware of their fertility status.  But, with just a little bit of knowledge and practice, NFP can be easily practiced during breastfeeding and the post-partum period.

The most common bodily observations used for NFP during the post-partum period are cervical mucus, cervical position, and basal body temperature.  The Marquette method involves the use of an electronic urine ovulation detector.  I strongly recommend the book, Art of Natural Family Planning® Postpartum Student Guide, available through The Couple to Couple League.  Also recommended are: Breastfeeding and Natural Child Spacing by Sheila Kippley, and Natural Family Planning: The Complete Approach by John and Sheila Kippley.

So, what is the best method of birth control while breastfeeding and during the first few months after childbirth?  Natural Family Planning!  It is hormone-free and safe for mother and baby.  There are no inconvenient barriers, gels, creams or foams.  It is very low cost.  It is reliable and effective with just a small amount of education.

Copyright 2011 Kathleen Mary Berchelmann, M.D. 


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  1. For me, with both of my daughters, breastfeeding has worked as birth control. My cycle didn’t come back with my first daughter until I started weaning her at 14 months, and my cycle hasn’t returned yet with my second daughter (who is 15 months and still nursing regularly, including twice a night). Nearly every mom I mention this to say “yeah, but you could still get pregnant…” Okay, sure. I’m aware of that. I’m okay with that. Still, breastfeeding works as birth control for me (though I have lots of friends that it doesn’t work for).

  2. I agree with most of your article but I disagree with your understanding on what NFP is. Natural Family Planning is NOT a method of birth control. It is instead a method of prolonging the duration of a mother conceiving a child due to serious reasons. Please do your research on the Church’s teachings on NFP. Please watch this quick video from Michael Vorris giving a brief explaination of the Church’s teachings on NFP

  3. It would be nice if someone writing an article on NFP would actually discuss how to do it instead of chickening out and just recommending a book. However I guess I can see how a good Catholic would have a hard time discussing the workings of the female reproductive organs. Oh well. I’m contemplating NFP while breastfeeding but am not interested in purchasing a book just to see if it sounds reasonable.

  4. Dear JR,

    I am very happy to provide you with an updated copy of the Couple to Couple League’s book on NFP while breastfeeding and during the postpartum period. I wrote this post some time ago, and there is a new version out now called “Art of Natural Family Planning ® Transitions Student Guide.” You can contact me through my personal website

  5. Do you have any information if you want to conceive and your still breastfeeding? My baby is now 19 months old. I started my period again when she turned one. However my cycles are irregular 24-30 day cycles. Which method should I use to test my fertility?

  6. NFP while breastfeeding is NOT easy. Did a man write this article? Seriously?! My cycle came back 3 months after giving birth and I’m still breastfeeding 24/7. I am so tired of people saying what a wonderful simple practice NFP is. It’s time consuming, it’s unreliable, and it’ll do everything in its power to destroy your marriage. Let’s stop lying to all the poor engaged couples out there that NFP is so reliable and great. I do it because it’s the right thing but seriously. Let’s be honest about it.

  7. I appreciate your article. I agree but I do also wish someone would just get into how. Especially if you say it only requires a small amount of education.

  8. I have been bleeding on and off since I gave birth 2 months ago. There’s no way to tell if it is lochia or menstruation. NFP right now is tricky as hell and since I had a CS, I have a very very serious reason to not get pregnant for the next 1 year.
    I’m breastfeeding exclusively, but seeing how I’m bleeding, I am quite certain breastfeeding will not help me.
    What happens if NFP fails and I get pregnant before 1 year elapses??

    • Dear Jovie,
      I’ve read your comment and the one on the other article you read today. And I understand your deep concern. Unfortunately Dr. Kathleen Berchelmans is no longer an active contributor at and might not reply to this comment. I would recommend that you discuss your concerns with an OB/GYN who is familiar with NFP, particularly a NaPro practitioner. This might be a good starting point:
      You’re in my prayers today! Having had birth complications, I know how scary it is. I hope you find answers from helpful experts, and peace for your heart.

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